Yes, I want to help Clean Water Action campaign to protect our environment, health, economic well-being and community quality of life.

First Name: *

Last Name: *

Email: *

Phone: *

Street: *

City:

State: *

Zip/Postal code: *

Tell us how you wold prefer to be contacted: *

Here are ways I am willing to help:From home or work: Write letters, make phone calls and send e-mails to public leaders, including my elected officials and agency representatives, about clean water issues when the time is right. Clean Water Action will provide me with information and background materials and let me know when to take action so that my contact will have the greatest impact.

I will write letters to or sign petitions to be delivered to public leaders, including my elected officials and agency representatives.

I will write letters to the editor.

I will make phone calls to public officials.

In my neighborhood: Host a local meeting or house party to help raise awareness in my community about key issues, educate my neighbors on how they can make a difference and provide financial support for Clean Water Action. Clean Water Action will provide helpful tips, sample invitations, and other materials to make my event successful and fun.

I want to host a house party.

I am interested in volunteering in my community.

At Clean Water offices or events: Volunteer my time at a local Clean Water Action office or other nearby location, participate in community meetings and public events, or join other members and volunteers for phone banks, "mailing parties" and other clean water campaign activities.

Give my time at a local Clean Water Action office or other nearby location.

I am available: (please check all that apply)

I'm willing to come to the Clean Water Action office or campaign center and make election related calls.

I will help distribute election related materials.

Please list other events or activities for which you'd be willing to volunteer.:

Please list any special skills that you think would be useful in your role as a volunteer.: